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LLETZ (Large loop excision of the transformation zone)

  • Posted on- Apr 16, 2018
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What is an LLETZ?

LLETZ stands for large loop excision of the transformation zone. This procedure will remove a small segment of the cervix (the lower part of your womb or uterus).

What is a cone biopsy?

A cone biopsy is a less common surgical procedure where a cone-shaped or cylinder-shaped piece of the cervix is removed.

Why are they performed?

These procedures are performed for the diagnosis and treatment of pre-cancerous cells of the cervix. The patient should have a clear understanding of his reason for this surgery – if not, please ask the doctor.

What are the alternatives?

An LLETZ or a cone biopsy is recommended in order to treat pre-cancer cells. If the patient chose not to undergo treatment, there is a strong likelihood that these changes would progress to cancer over some years. If she did not have the treatment it would be essential for her to have an ongoing close follow-up in the colposcopy clinic.

How are they performed?

The procedure is usually performed under a local anesthetic. The cervix is examined using a special microscope called a colposcope. A fine wire loop charged with electricity is used to shave away the abnormal tissue from the cervix.

Because the procedure is so exact, and the loop very thin, very little damage is done to the tissue surrounding the area that needs to be removed. The procedure allows for the blood vessels surrounding the area to be sealed.

A cone biopsy is more commonly performed under a general anesthesia. The abnormal cells are often cut out with a knife. Dissolvable sutures are used to stop the bleeding. Both procedures take approximately fifteen minutes or more.

What are the risks of undergoing this procedure?

Although the risks associated with an LLETZ procedure or a cone biopsy is low, the patient should be aware that every surgical procedure has some risk.

There are some specific risks to be aware of in relation to this operation:

  • Excessive bleeding from the cervix, which may need a blood transfusion or further surgery, either initially or within weeks of the procedure.
  • Infection may be introduced into the cervix, uterus, tubes or abdomen. This may require treatment with antibiotics.
  • Sometimes not all of the abnormal tissue is completely removed, requiring further surgery
  • Uncommonly, the cervix may be weakened by this procedure resulting in a slight increase in the future pregnancy risk of a late miscarriage or preterm birth.
  • Rarely the cervix may be damaged and narrowed leading to painful periods, difficulty in performing adequate pap smears, or problems in the progress of a future labor.

What should the patient do before the procedure?

  • Any tests or referrals arranged at the patient’s outpatient stage should be completed.
  • The patient should continue his regular medications, unless advised otherwise.
  • Stop smoking.

What should the patient do on the day of the procedure?

Unless otherwise specified, the patient should stop eating and drinking, at the following times on the day of the surgery:

  • at midnight for a morning procedure
  • at 6 am for an afternoon procedure

The patient should continue all his usual medications unless otherwise specified. The patient should shower and remove any body jewellery.

The patient should bring:

  • nightgown
  • underwear
  • sanitary pads
  • all usual medications
  • all X-rays.

What should the patient expect after the procedure?

The patient should be able to leave the hospital that day. The patient will be given specific discharge medication if required, but she may use paracetamol or paracetamol-codeine as required (one to two tablets every four hours up to a maximum of eight tablets per day).

The patient should expect a bloody vaginal discharge for several days after the procedure, which should settle within one to two weeks. A clear discharge may persist for up to six weeks.

The patient should be able to return to work the following day but may require more time off from work, depending on the procedure performed. Follow up appointments are very important to ensure that all of the abnormal cells have been removed.

After discharge from the hospital, the patient should:

  • eat and drink normally
  • remain mobile
  • use sanitary pads (not tampons) if required
  • Shower normally (in preference to bathing).

The patient should not:

  • have intercourse for four weeks


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